Differential diagnosis of enophthalmos due to diseases of the paranasal sinuses.

Background: Spontaneous enophthalmos without recent trauma is a rare condit ion. Its origin is difficult to evaluate. Method: Specific properties of th is symptom complex are presented based on a literature review and on case r eports. Possible connections between enophthalmos and paranasal sinus disea ses as well as differential diagnoses are analysed. Patients: 1. 31 year ol d female patient with right spontaneous enophthalmos and no history of trau ma. CT-imaging disclosed tissue formation in the maxillary sinus, partially destroyed medial orbital wall and floor, descended orbital contents follow ing Caldwell-Luc procedure several yea rs previously. After endonasal surge ry of ethmoidal and maxillary sinus with removal of a large cyst good funct ional and cosmetical result. 2. 25 year old male patient complaining of pai n in the periorbital region, presenting with left enophthalmos and superona sal deviation of the eyeball. MRI and CT revealed a tumor in the orbital fl oor region with total destruction of the roof of the maxillary sinus. Remov al of the tumor by a combined lateral rhinotomy and subciliary approach. Di agnosis: Leiomyoma. Orbital reconstruction with PDS-sheet. Postoperatively, improved globe position and motility. No recurrence during three year foll ow-up. Conclusion: When evaluating the causes of enophthalmos, chronic dise ases of the paranasal sinuses or their walls must be considered. Surgical t herapy is promising.